Wednesday, May 25, 2022

Obese transfemoral patients and proximal socket discomfort

William Lifford

Hello fellow listmembers,

Recently I’ve had several transfemoral amputee patients in to be fitted =
for new sockets. What are some typical modifications or changes that =
you find you have to make in order to accomodate these types of =
patients?

For example: The patient’s thighs touch together quite firmly all the =
way up into the perineum. Rolling the medial brim of the flexible inner =
socket is not really possible because then the contralateral thigh is =
chafed; however, cutting the brim shorter but leaving it almost vertical =
produces some discomfort upon weightbearing. If the brim is cut too =
short, there is a medial roll of tissue. What can you do in these =
circumstances? =20

Another example: The patient’s pendulous abdomen is chafed by the =
anterior flexible brim. A “standard” size rolled edge helps while =
standing, however, when sitting the edge really irritates the tissue. =
If you build out the brim of the cast and then have a large rolled brim, =
it protrudes too far anteriorly to have an acceptable cosmesis. Any =
thoughts on what other options are available?

I’m sorry if these examples are poorly articulated/worded, but I’m =
trying to illustrate the “Catch-22” type situations I seem to find =
myself in while serving these patients. I’d really appreciate your =
thoughts on this matter…. I’ll post a summary of responses in a few =
days.

Thanking you in advance,

Bill Lifford, C.P.

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